Forum - Questions & Answers

Oct 10th, 2019 - lhaas01 13 

HCPCS Code for a Strassburg Sock

I am unsure of which code is to be used when billing for a Strassburg Sock. We have been using the code A4570. That seems to reject as "lacking information/billing error". I am not sure if that is the correct code we should use.. Any advise would be greatly appreciated.

Thank you

Oct 10th, 2019 - ChrisW   256  1 

re: HCPCS Code for a Strassburg Sock

I would suggest consulting your payer. It may also depend on the diagnosis and what you are treating, are you using to restrict or eliminate motion?

I would suggest consulting your commercial payer guidelines or LCD if applicable for coverage and medical necessity. If your claim is lacking information, it could also be what is required to bill DME, are you billing CMS? Reminder to report any applicable modifiers, Have all conditions been met? Use the KX Modifier. Are you using a code that needs a fitting? Are you reporting the correct place of service, DME is appropriate for home use.

I say to consult your payer because I was seen where BC and Cigna may pay on the following codes for a Strassburg Sock.
L4397 - Static or dynamic ankle-foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf
L1930 - Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment

In addition, if the supply is elastic and similar stretchable materials it does not meet the definition of a brace.
According to “Ankle-Foot/Knee-Ankle-Foot Orthoses” – CMS Policy Article (A52457)
“Elastic or other fabric support garments (A4467 (BELT, STRAP, SLEEVE, GARMENT, OR COVERING, ANYTYPE) with or without stays or panels do not meet the statutory definition of a brace because they are not rigid or semi-rigid devices.”

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